Healthcare Provider Details

I. General information

NPI: 1437174745
Provider Name (Legal Business Name): RICHARD J VANCALCAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 E 8TH ST
PORT ANGELES WA
98362-6219
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-3373
  • Fax: 360-457-2163
Mailing address:
  • Phone: 360-565-9240
  • Fax: 360-565-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00012488
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: